March was Endometriosis Awareness Month; there are are numerous avenues to help manage this serious medical condition, including physical therapy! Check out this TEDx Talk for facts and figures regarding endometriosis and ask your CTS physical therapist any questions you may have.

Over the years I have treated a lot of patients with pain disorders. They are scared and getting out of pain consumes their thoughts and their lives. They want to "fix" it and will often seek out several healthcare professionals and will try anything to get "it" to go away. I have been in this same cycle of pain with a nerve entrapment/stretch injury. Every muscle in my body was guarding around this nerve and I thought my world was coming to an end, that it would never go away, and I was going to be like this forever. This happened to me 3 weeks before my husband and I were taking our 2 small children on an adventure to Peru. I did everything to get out of pain: Physical therapy, chiropractic, drugs, and acupuncture. Nothing helped. The thought of sitting on a plane for 10 hours was unthinkable.

But there I found myself, in coach with a child passed out on my lap and I couldn't do anything about my pain. I had to just "Let Go" and stop trying so hard to fix it. Two days later, my pain disappeared.

That process of "Letting Go" for me was the starting point for what was a sequence of events that led to where I am now. I realized the label we put on disease or dysfunction, the fearful thoughts about what we think about that label, the need to fix it because it seems so imperfect, is all just part of the problem of keeping us stuck in the pain and dysfunction. I frequently tell clients, "The bigger picture wins." The resistance, the fight to fix, the thoughts of negativity and dysfunction, the thoughts of never being the same again, will win if that is what is most prevalent. The bigger picture wins!

So why not create a new bigger picture?

My bigger picture was having an amazing time trekking though the Amazon Jungle and exploring Machu Picchu with my family. It won!

Could it be true that what we hold in our minds is what we are living? Do our thoughts create our reality or at least contribute? I have heard similar stories to mine with chronic pain that has haunted them much longer than my pain cycle. Their lives are consumed by doctors appointments and procedures. It becomes like a full time job trying to figure out how to "fix it". Then, they go away on vacation and their pain goes away. When they return to their full time job of doctors appointments, PT appointments, etc. Their pain returns. Why? This is the mind/body connection.

So, what can we do differently?
  1. Start observing your thoughts; If you don't like something in your life, look at your thoughts about it. How much energy are you giving this? If you notice that your monkey brain is going crazy and just can't stop, notice it, then say "cancel" and physically do something different in that moment. Walk the other direction, do a spin, whatever. Change your thoughts to match what you want in life. I know, it sounds "airy fairy" but give it a go.

  2. Everyday, take steps toward wellness not illness; Learn about what you can do with food to empower your body's natural healing ability. Be in nature. Breathe. Seek out healthcare professionals that see you as "whole and perfect" not in need of "fixing". Those who are willing to really be there to help facilitate healing but not "fix" you.

  3. Talk to your tissues; You may feel crazy doing this at first, but you will be amazed at the response. Think of your cells as their own living and breathing beings. Talk to the area in pain. Ask what it is trying to tell you and then listen. If you have had a surgery or trauma, speak to that area like you are nurturing a small child acknowledging how afraid they must have been. If you need surgery, talk to your body and your tissues before. Tell your body what is going to happen and how you will be there to support it.

  4. Practice getting into your body; Lay down in a quiet and comfortable place. Start by noticing your left foot. Put all of your awareness in your foot. Don't judge it, just notice it. Then do the same with your right foot. Do they feel the same or different. Do this same exercise with all areas of your body. Then start doing it with your pain. Feel the area in pain. Keep your awareness on it. Feel it. Even love it. We do so much to get it to leave -why not try loving it instead? LIsten to it. With all this attention, you may start to physically feel a release, a softening in the tissue. This is your body trying to heal itself.
Happy Healing Everyone!
Kim Zevin, DPT
Have you ever felt like you can't participate in a sport because of your pelvic floor dysfunction? Or have you heard that you should avoid certain movements and activities to protect your pelvic floor from harm? According to the Physiodetective, Antony Lo, it's time to re-think the way we handle some common women's health issues, including stress urinary incontinence, pelvic organ prolapse, chronic pelvic pain, and diastasis recti. Using his "bulletproof" strategy for core and pelvic floor rehab (which is aimed at crossfit-ers, but can be applied to anyone), we can return our patients to running, lifting heavy weights, or even doing crunches!

One of Antony's core tenants of rehabilitation is utilizing a variety of movements to accomplish the same task. For example, if your squat feels awkward or painful when you use the "traditional" approach of feet hip width apart, toes forward, back straight, etc., try something different! Turn your toes out, widen or stagger your stance, practice a high bar or front squat instead of a low bar squat.

As long as movement is controlled and pain free, it is not bad for you! This also implies that there is no such thing as "correct" alignment or movement, just some that are more efficient than others.

Of course, as the task at hand gets more advanced, such as performing a 400 pound deadlift vs. picking a child's toy up from the ground, there is less room for variability. However, training in numerous ways can better prepare you for your big performances - As Antony says, the more ways you can perform a task, the more resilient you are, which makes you harder to kill, and therefore more awesome!

Another important point of Antony's is exercises we traditionally think of as dangerous to the pelvic floor can actually be as safe as any other, as long as you are in control of the movement. Take a bicycle crunch, for example - an exercise that crossfit athletes perform often, but we as therapists often shy away from as it puts "too much" downward pressure on the pelvic floor. Recent evidence has indicated that this is not, in fact, the case.

Studies have shown that crunches, V-sits, bicycles, etc. all create less intra-abdominal pressure than everyday tasks such as standing up from a chair, lying down supine on the floor, or even walking.

Additionally, there is a tendency among pelvic floor physical therapists to stress avoiding breath holding. Though the exhale on exertion technique is useful in many instances, it is impossible to lift heavy weights without holding breath. This suggests that technique may matter more than the breathing itself - if we are having difficulty controlling the intra-abdominal pressure with breath held, we need to look for the "leaks" in the system to correct them.

This leads us to the more practical component of bulletproofing the core and pelvic floor - how to perform a pelvic brace for optimal performance. Antony's evidence-based belief is that...

It is absolutely necessary to tap into the nervous system to effect big changes.

Once you have seen a pelvic floor physical therapist to manage pain and learn how to activate muscles, it is vital to put your new skills to use by re-educating the neural pathways that connect the brain to the core and pelvic floor. This can be done by first utilizing a pattern of "lighting up" the core muscles. Once the pathway has been activated and the muscles are ready, add to this a cue - it can be snapping your fingers, slapping your thighs, hearing a word, anything. Adding your cue to the activation pattern will trigger your brain to use the pathway automatically in preparation for a movement. Then, when you are ready to perform, think about "spreading the load." This means feeling where your breath resides in your body as well as which muscles are dominantly active and spreading that as far as you can to have numerous avenues of regulating pressure. After performing your cue and spreading the load, you're ready to move without symptoms!

Get out there and lift heavy, my friends!
Jessica Swartz, PT, DPT